Can Probiotics Prevent C. difficile-Associated Diarrhea?

Randomized control trials examining probiotics for prevention of CDAD were included in the analysis.

Probiotics may be effective for preventing C. difficile-associated diarrhea (CDAD), based on results from a new systematic review and meta-analysis.

For this study, researchers searched PubMed, EMBASE, CENTRAL, and the Cochrane IBD Group Specialized Register up until March 21, 2017 to identify trials investigating probiotic use for the prevention of CDAD or C. difficile infection; a total of 39 studies were included in the analysis (n=9955).

The primary outcome was the incidence of CDAD. Included in secondary outcomes were detection of C. difficile infection, adverse events, antibiotic-associated diarrhea (AAD) and length of hospital stay.

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Results from the studies investigating CDAD incidence (31 trials, n=8,672) showed that probiotics reduce the risk of CDAD by 60%. Among the probiotic group, the incidence of CDAD was 1.5% (70/4,525) vs 4% (164/4,147) in the placebo or no treatment group (RR 0.40; 95% CI; 0.30 to 0.52). However, regarding the detection of C. difficile in the stool, pooled results from 15 trials did not show a significant reduction in infection rates; the infection rates were 15.5% (98/633) for the probiotics group vs 17.0% (99/581) for the placebo or no treatment control group (RR 0.86, 95% CI 0.67 to 1.10).

The researchers also detected a subgroup difference in CDAD development. Trials with a baseline CDAD risk of <5% did not demonstrate any difference in risk but those patients with a baseline risk of >5% for CDAD had a significant (70%) risk reduction (P=0.01). Incidence of CDAD among the baseline risk group of >5% was 3.1% (43/1,370) vs 11.6% (126/1,084) in the control group (RR 0.30, 95% CI 0.21 to 0.42).

"The short-term use of probiotics appears to be safe and effective when used along with antibiotics in patients who are not immunocompromised or severely debilitated," the authors concluded.